Protecting Children's Health During and After Natural Disasters
Children’s Health in the Aftermath of Floods
Children are different from adults. They may be more vulnerable to chemicals and organisms they are exposed to in the environment because:
- Children’s nervous, immune response, digestive and other bodily systems are still developing and are more easily harmed;
- Children eat more food, drink more fluids, and breathe more air than adults in proportion to their body size – so it is important to take extra care to ensure the safety of their food, drink and air;
- They way children behave – such as crawling and placing objects in their mouths – can increase their risk of exposure to chemicals and organisms in the environment.
Choose from the topics below to learn more about potential hazards to children's health after floods:
- Carbon Monoxide
- Contaminated Water
- Extreme Heat
- Household Items Contaminated by Floodwaters
- Other Flood Topics
- Clinician Recommendations Regarding Return of Children to Areas Impacted by Flooding and/or Hurricanes: A Joint Statement from the Pediatric Environmental Health Specialty Units and the American Academy of Pediatrics (PDF) Exit(3 pp, 73K)
- EPA's Flooding Web Page
- Insect Repellent
- Volcanic Ash
Also, find Pediatric Environmental Health Specialty Units (PEHSU's) in your area, learn more about PEHSU's Exit, or download a copy of this information (PDF) (5 pp, 307K, About PDF).
After homes have been flooded, moisture can remain in drywall, wood furniture, cloth, carpet, and other household items and surfaces and can lead to mold growth. Exposure to mold can cause hay-fever-like reactions (such as stuffy nose, red, watery or itchy eyes, sneezing) to asthma attacks. It is important to dry water-damaged areas and items within 24-48 hours to prevent mold growth. Buildings wet for more than 48 hours will generally contain visible and extensive mold growth.
Some children are more susceptible than others to mold, especially those with allergies, asthma and other respiratory conditions. To protect your child from mold exposure, you can clean smooth, hard surfaces such as metal and plastics with soap and water and dry thoroughly. Flood water damaged items made of more absorbent materials cannot be cleaned and should be discarded. These items include paper, cloth, wood, upholstery, carpets, padding, curtains, clothes, stuffed animals, etc.
If there is a large amount of mold, you may want to hire professional help to cleanup the mold. If you decide to do the cleanup yourself, please remember:
- Clean and dry hard surfaces such as showers, tubs, and kitchen countertops.
- If something is moldy, and can't be cleaned and dried, throw it away.
- Use a detergent or use a cleaner that kills germs.
- Do not mix cleaning products together or add bleach to other chemicals.
- Wear an N-95 respirator, goggles, gloves so that you don't touch mold with your bare hands, long pants, a long-sleeved shirt, and boots or work shoes.
Homes or apartments that have sustained heavy water damage will be extremely difficult to clean and will require extensive repair or complete remodeling. We strongly advise that children not stay in these buildings. Find more mold resources or read EPA's brochure, "Flood Cleanup and the Air in Your Home (PDF)" (15 pp, 1.1MB, About PDF).
NEVER use portable generators indoors! Place generators outside and as far away from buildings as possible. Do not put portable generators on balconies or near doors, vents, or windows and do not use them near where you or your children are sleeping. Due to loss of electricity, gasoline- or diesel-powered generators may be used in the aftermath of floods. These devices release carbon monoxide, a colorless, odorless and deadly gas. Simply opening doors and windows or using fans will not prevent carbon monoxide buildup in the home or in partially enclosed areas such as a garage. In 2001 and 2002, an average of nearly 1,000 people died from non-fire-related carbon monoxide poisoning, and 64% of nonfatal carbon monoxide exposures occurred in the home.
If your children or anyone else in your family starts to feel sick, dizzy or weak or experiences a headache, chest pain or confusion, get to fresh air immediately and seek medical care as soon as possible. Your child’s skin under the fingernails may also turn cherry-red if he/she has been exposed to high levels of carbon monoxide. Fetuses and infants are especially vulnerable to the life-threatening effects of carbon monoxide.
Install a carbon monoxide detector that is Nationally Recognized Testing Laboratory (NRTL) approved (such as UL Exit). These are generally available at local hardware stores. Carbon Monoxide is lighter than air, so detectors should be placed closer to the ceiling. Detectors should be placed close enough to sleeping areas to be heard by sleeping household members.
Learn more about carbon monoxide from the National Institute for Occupational Safety and Health, the Centers for Disease Control and Prevention, and FIRST ALERT® Exit.
While all people need safe drinking water, it is especially important for children because they are more vulnerable to harm from contaminated water. If a water source may be contaminated with flood waters, children, pregnant women and nursing mothers should drink only bottled water, which should also be used to mix baby formula and for cooking. We also recommend you sponge bathe your children with warm bottled water until you are certain your tap water is safe to drink.
Your child may or may not show symptoms or become ill from swallowing small amounts of contaminated water. Symptoms can vary by contaminant. If your child drinks water contaminated with disease-causing organisms, he/she may come down with symptoms similar to the “stomach flu.” These include stomach ache, nausea, vomiting, and diarrhea, and may cause dehydration.
Some contaminants, such as pesticides and gasoline, may cause the water to smell and taste strange, and others such as lead and disease-causing organisms may not be detectable. Drinking water contaminated with chemicals such as lead or gasoline may not cause immediate symptoms or cause your child to become ill but could still potentially harm your child’s developing brain or immune system.
Because you cannot be sure if the water is safe until private wells are professionally tested or city water is certified as safe by local officials, we urge parents to take every precaution to make sure their child’s drinking water is safe.
If you have a flooded well, do NOT turn on the pump, and do NOT flush the well with water. Contact your local or state health department or agriculture extension agent for specific advice on disinfecting your well. View more information on how to manage a flooded well.
Your public water system or local health agency will inform you if you need to boil water prior to using it for drinking and cooking. View additional information about emergency disinfection of drinking water.
Tap water that has been brought to a rolling boil for at least 1 minute will kill disease-causing organisms. Boiling will not remove many potentially harmful chemicals, and may actually increase concentrations of heavy metals (including lead), which can be harmful to a child’s developing immune system. Chemically treating tap water with either chlorine or iodine will kill many disease-causing organisms, but will not remove harmful chemicals or heavy metals.
Household Items Contaminated by Floodwaters
Drinking Water Containers: Clean thoroughly with soap and water, then rinse. For gallon-sized containers, add approximately 1 teaspoon of bleach to a gallon of water to make a bleach solution. Cover the container and agitate the bleach solution thoroughly, allowing it to contact all inside surfaces. Cover and let stand for 30 minutes, then rinse with potable water.
Kitchenware and Utensils: In general, metal and glazed ceramic that are thoroughly washed and dried can be sanitized and kept. Follow local public health guidance on effective and safe sanitation procedures. Wood items must be thrown away, as these items can absorb contaminants or grow mold from the exposure to flood water and they cannot be properly sanitized.
Children's Toys and Baby items: Throw away ALL soft or absorbent toys because it is impossible to clean them and they could harm your child. Throw away ALL baby bottles, nipples, and pacifiers that have come in contact with flood waters or debris.
Other Flood Topics
Teenagers: Teens are still growing and developing, especially their reproductive, nervous and immune systems. Teens are less likely to understand dangers and may underestimate the dangers of certain situations, or they may be reluctant to voice their concerns about potential dangers. Whenever possible, teens should not participate in post-flood clean-up that would expose them to contaminated water, mold and hazardous chemicals. Older teens may help adults with minor clean-ups if they wear protective gear including goggles, heavy work gloves, long pants, shirts, socks, boots and a properly fitting N-95 respirator.
Older Adults and People Living with Chronic Diseases: Flooding often leads to the development of micro-organisms and the release of dangerous chemicals in the air and water. Older adults and people living with chronic diseases are especially vulnerable to these contaminants.
Bleach: Household bleach contains chlorine, a very corrosive chemical which can be harmful if swallowed or inhaled. It is one of the most common cleaners accidentally swallowed by children. Children – especially those with asthma – should not be in the room while using these products. Call Poison Control at (800) 222-1212 immediately in case of poisoning.
Formerly Flooded or Debris-filled Areas: Children in these areas may be at risk of exposure to dirt and debris that may have been contaminated with hazardous chemicals like lead, asbestos, oil and gasoline. Children can be exposed by direct contact through their skin, by breathing in dust particles or fumes, or by putting their hands in their mouths.
Mosquitoes and Disease-Causing Pests: Flood water may increase the number of mosquitoes and other disease-causing pests. To protect your child, ensure that they use insect repellents containing up to 30% Deet, Picardin, or Oil of Lemon Eucalyptus. The American Academy of Pediatrics recommends that Deet not be used on infants less than 2 months of age and that Oil of Lemon Eucalyptus not be used on children under 3 years of age. Other ways to protect children include staying indoors while the sun is down, wearing light colored, long sleeved shirts and pants, covering baby carriages and playpens with mosquito netting, and clear standing water or empty flower pots, etc of water.
Pediatric Environmental Health Specialty Units
To access experts children’s environmental health issues related to flooding, please contact the Pediatric Environmental Health Specialty Units in your area:
The following links exit the site Exit
Region 7 - Iowa, Kansas, Missouri, Nebraska and nine Tribal Nations – (800) 421-9916
Region 10 - Alaska, Idaho, Oregon, Washington, and Native Tribes – (877) 543-2436
Heat-related illnesses are common, yet preventable on hot days. Children and pregnant women need to take extra precautions to avoid overheating on days of extreme heat. Dehydration, heat stroke, and other heat illnesses may affect a child or pregnant woman more severely than the average adult. Download a copy of this information (PDF) (2 pp, 80K, About PDF).
Why are children more susceptible to extreme heat?
- Physical characteristics – Children have a smaller body mass to surface area ratio than adults, making them more vulnerable to heat-related morbidity and mortality. Children are more likely to become dehydrated than adults because they can lose more fluid quickly.
- Behaviors – Children play outside more than adults, and they may be at greater risk of heat stroke and exhaustion because they may lack the judgment to limit exertion during hot weather and to rehydrate themselves after long periods of time in the heat. There are also regular reports of infants dying when left in unattended vehicles, which suggests a low awareness of the dangers of heat events.
How do I know if my child is dehydrated?
- Decreased physical activity
- Lack of tears when crying
- Dry mouth
- Irritability and fussiness
What should I do if my child has become dehydrated?
- Have the child or infant drink fluid replacement products
- Allow for rehydration to take a few hours, over which children should stay in a cool, shaded area and sip fluids periodically
- Call your doctor if symptoms do not improve or if they worsen
How do I know if my child has suffered a heat stroke?Heat stroke, a condition in which the body becomes overheated in a relatively short span of time, can be life-threatening and requires immediate medical attention.
- Skin is flushed, red and dry
- Little or no sweating
- Deep breathing
- Dizziness, headache, and/or fatigue
- Less urine is produced, of a dark yellowish color
- Loss of consciousness
What should I do if my child has suffered a heat stroke?
- Immediately remove child from heat and place in a cool environment
- Place child in bath of cool water and massage skin to increase circulation (do not use water colder than 60F – may restrict blood vessels)
- Take child to hospital or doctor as soon as possible
How can children be protected from the effects of extreme heat?
- Hydration – Make sure children are drinking plenty of fluids while playing outside, especially if they are participating in sports or rigorous physical activity. Fluids should be drunk before, during and after periods of time in extreme heat.
- Staying indoors – Ideally, children should avoid spending time outdoors during periods of extreme heat. Playing outside in the morning or evenings can protect children from dehydration or heat exhaustion. Never leave a child in a parked car, even if the windows are open.
- Light clothing – Children should be dressed in light, loose-fitting clothes on extremely hot days. Breathable fabrics such as cotton are ideal because sweat can evaporate and cool down the child’s body.
How do I care for my infant during hot weather?
- Check your baby’s diaper for concentrated urine, which can be a sign of dehydration.
- If your infant is sweating, he or she is too warm. Remove him or her from the sun immediately and find a place for the baby to cool down.
- Avoid using a fan on or near your baby; it dehydrates them faster.
- A hat traps an infant’s body heat and should only be worn in the sun to avoid sunburn.
- Never leave an infant in a parked car, even if the windows are open.
Why are pregnant woman especially at risk during periods of extreme heat?
An increase in the core body temperature of a pregnant woman may affect the fetus, especially during the first trimester.
How can pregnant women protect themselves from the effects of extreme heat?
- Wear light loose fitting clothing
- Stay hydrated by drinking six to eight glasses of water a day
- Avoid caffeine, salt, and alcohol
- Balance fluids by drinking beverages with sodium and other electrolytes
- Limit midday excursions when temperatures are at their highest
- Call doctor or go to emergency room if woman feels dizzy, short of breath, or lightheaded
Wildfires expose children to a number of environmental hazards, e.g., fire, smoke, psychological
conditions, and the byproducts of combustion. After a wildfire, children may be exposed to a different set of
environmental hazards involving not only their homes, but also nearby structures, land, and
- Fact Sheets on Health Risks of Wildfires for Children, from PESHU
- Wildfire Smoke: A Guide for Public Health Officials (PDF) (53 pp, 2MB)
Volcanic ash consists of tiny pieces of rock and glass that is spread over large areas by wind. During volcanic ash fall, people should take measures to avoid unnecessary exposure to airborne ash and gases. View basic information about volcano safety.
Short-term exposure to ash usually does not cause significant health problems for the general public, but special precautions should be taken to protect susceptible people such as infants and children. Most volcanic gases such as carbon dioxide and hydrogen sulfide blow away quickly. Sulfur dioxide is an irritant volcanic gas that can cause the airways to narrow, especially in people with asthma. Precaution should be taken to ensure that children living close to the volcano or in low-lying areas (where gases may accumulate) are protected from respiratory and eye irritation.
While children face the same health problems from volcanic ash particles suspended in the air as adults (namely respiratory and irritation of the nose, throat, and eyes), they may be more vulnerable to exposure due to their smaller physical size, developing respiratory systems, and decreased ability to avoid unnecessary exposure. Small volcanic ash particles - those less than 10 micrometers in diameter - pose the greatest health concern because they can pass through the nose and throat and get deep into the lungs. This size range includes fine particles, with diameters less than 2.5 micrometers, and coarse particles, which range in size from 2.5 to 10 micrometers in diameter. Particles larger than 10 micrometers do not usually reach the lungs, but they can irritate your eyes, nose, and throat. The volcanic ash may exacerbate the symptoms of children suffering from existing respiratory illnesses such as asthma, cystic fibrosis, or tuberculosis.
Precautions for Children if Ash is Present
- Always pay attention to warnings and obey instructions from local authorities.
- Check the Air Quality Index forecast for your area.
- Stay alert to news reports about volcanic ash warnings.
- Keep children indoors.
- Children should avoid running or strenuous activity during ash fall. Exertion leads to heavier breathing which can draw ash particles deeper into the lungs.
- Parents may want to plan indoor games and activities that minimize activity when ash is present.
- If your family must be outdoors when there is ash in the air, they should wear a disposable mask. If no disposable masks are available, make-shift masks can be made by moistening fabric such as handkerchiefs to help to block out large ash particles.
- Volcanic ash can irritate the skin; long-sleeved shirts and long pants should be worn if children must go outdoors.
- Children should not play in areas where ash is deep or piled-up, especially if they are likely to roll or lie in the ash piles.
- Children should wear glasses instead of contact lens to avoid eye irritation.
- Create a “clean room” where children sleep and play to help to minimize exposure to ash in indoor air.
- Keep windows and doors closed. Close any vents or air ducts (such as chimneys) that may allow ash to enter the house.
- Run central air conditioners on the "recirculate" option (instead of "outdoor air intake"). Clean the air filter to allow good air flow indoors.
- Avoid vacuuming as it will stir up ash and dust into the air.
- Do not smoke or burn anything (tobacco, candles, incense) inside the home. This will create more indoor pollutants.
- If it is too warm or difficult to breathe inside with the windows closed, seek shelter elsewhere.
- A portable room air filter may be effective to remove particles from the air.
- Choosing to buy an air cleaner is ideally a decision that should be made before a smoke/ash emergency occurs. Going outside to locate an appropriate device during an emergency may be hazardous, and the devices may be in short supply.
- An air cleaner with a HEPA filter, an electrostatic precipitator (ESP), or an ionizing air cleaner may be effective at removing air particles provided it is sized to filter two or three times the room air volume per hour.
- Avoid ozone generators, personal air purifiers, "pure-air" generators and "super oxygen" purifiers as these devices emit ozone gas into the air at levels that can irritate airways and exacerbate existing respiratory conditions. These devices are also not effective at removing particles from the air.
Pediatric Environmental Health Specialty Units (PEHSU). To access children's environmental health issues experts, please contact the Pediatric Environmental Health Specialty Unit (PEHSU) in your area . PEHSU in EPA Region 10 - Alaska, Idaho, Oregon, Washington, and Native Tribes -- (877) 543-2436.
For More Information
Anchorage Air Quality Volcano Information
Centers for Disease Control and Prevention (CDC) Key Facts About Volcanic Eruptions
Alaska Division of Homeland Security and Emergency Management: Volcanic Ash Preparedness
Air Quality Index (AIR Now) Local Advisories
U.S. EPA Guide to Air Cleaners in the Home (PDF) (12 pp, 247K)
The Health Hazards of Volcanic Ash: A Guide for the Public (PDF) (10 pp, 545K)
Guidelines on Preparedness Before, During and After an Ashfall (PDF) (10 pp, 499K)
Download a copy of this information (PDF) (2 pp, 137K, About PDF).